Other Public Health Resources

New Data Available from CDC - Disease Atlas

The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has available resources, data, and state health profiles online at http://www.cdc.gov/nchhstp/Default.htm. Included on this website is the NCHHSTP Atlas which recently released updated surveillance data including 2010 data for acute viral hepatitis A, B, C, and 2011 data for HIV, TB and STDs (chlamydia, gonorrhea, primary and secondary syphilis).

The NCHHSTP Atlas was created to provide an interactive platform for accessing data collected by CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). This interactive tool provides CDC an effective way to disseminate data, while allowing users to observe trends and patterns by creating detailed reports, maps, and other graphics.

Currently, the Atlas provides interactive maps, graphs, tables, and figures showing geographic patterns and time trends of HIV, AIDS, viral hepatitis, tuberculosis, chlamydia, gonorrhea, and primary and secondary syphilis surveillance data.

About the Data: CDC collects, analyzes, and disseminates data on the reported occurrence of nationally notifiable infectious diseases in the United States, including HIV, viral hepatitis, some STDs, and TB. More information regarding the surveillance data, rates, cases, and suppression rules can be found by clicking the "About these data and footnotes" link in the top right corner within the Atlas. The Atlas is available at http://www.cdc.gov/nchhstp/atlas/?s_cid=nchhstp-atlas-003.

April 8, 2013

Public Health and GAFP Offering Lunch and Education at Your Office

GAFP would like to offer you and your office staff the opportunity to learn more about the Public Health Programs for Newborn Metabolic and Hearing Screening, and Children 1st. Local public health coordinators for these programs will provide information on services, eligibility, and the referral process during a lunch and learn session.

To schedule, please contact Cathi Durham, Director of Outreach at 800.392.3841 or cdurham@gafp.org.

March 18, 2013

GAFP Members Encouraged to Sign Up for Health Alerts

The GAFP Congress of Delegates approved the following resolution at the November 2012 meeting: Resolve that the Georgia Academy of Family Physicians outreach to the Georgia Department of Public Health Chemical Hazards Project Director in order to offer assistance in the utilization and expansion of the Department of Public Health Physician Notification System for all Georgia when contaminants are found in drinking water in Georgia.

The Georgia Department of Public Health has available a service for all physicians to receive communication regarding matters of urgency. Register to receive these communications by emailing: askDPH@dhr.state.ga.us.

CDC has a national Health Alert Network (HAN) that has been operational since September 2011. Physicians, as well as members of the public, may register to be included in this network at http://emergency.cdc.gov/HAN/. Georgia is in the process of developing its own HAN for Georgia-specific issues.

January 24, 2013

Tobacco Cessation Resource for Family Physicians in Georgia

The Georgia Department of Public Health (DPH) is expanding its efforts to help Georgians quit smoking and stop using tobacco products. DPH is offering a four-week supply of free Nicotine Replacement Therapy to all uninsured Georgia tobacco users aged 18 and older.

The free Nicotine Replacement Therapy medication comes in the form of patches and gum. Uninsured Georgians who use tobacco and are ready to quit, can contact the Georgia Tobacco Quit Line at 1-877-270-STOP (7867) for the free therapies. The Georgia Tobacco Quit Line provides professional tobacco cessation telephone and web-based counseling free and confidentially to all Georgia tobacco users ages 13 and older including pregnant and postpartum women.

The Quit Line is available 24 hours a day and seven days a week. For additional tobacco cessation resources available at the Georgia Department of Public Health's Live Healthy Georgia website, click here.

December 6, 2012

Influenza Sentinel Providers � Contributing to the Public�s Health

What is an influenza sentinel provider?
An influenza sentinel provider conducts surveillance for influenza-like illness (ILI) in collaboration with the local and state health departments as well as the Centers for Disease Control and Prevention. Data reported by sentinel providers, in combination with other influenza surveillance data, provide a picture of influenza virus and ILI activity in the United States. Approximately 3,000 providers throughout the country were enrolled in this network during the 2011-2012 influenza season; 74 of them were Georgia sentinel providers.

What, how and to whom are data reported?
Sentinel providers report the total number of patient visits each week and the number of patient visits for influenza-like illness by age group (0-4 years, 5-24 years, 25-49 years, 50-64 years, ?65 years). These data are transmitted once a week over the Internet or via fax to CDC. Most providers report that it takes them less than 30 minutes a week to compile and report their data. In addition, sentinel providers submit specimens from a subset of patients for virus isolation free of charge monthly during the influenza season. The Georgia Public Health Laboratory types the viruses; many of these are then forwarded to CDC for viral characterization.

Who can be an influenza sentinel provider?
Providers of any specialty, such as family medicine, internal medicine, pediatrics, infectious diseases, in any type of practice (private practice, public health clinic, urgent care center, emergency room, university student health center, occupational medicine) are eligible to be sentinel providers.

Why volunteer?
Influenza viruses are constantly evolving and cause substantial morbidity and mortality every season. Data from sentinel providers are critical for monitoring the impact of influenza and, in combination with other influenza surveillance data, can be used to guide prevention and control activities, vaccine strain selection and patient care.

Sentinel providers receive feedback on the data submitted, summaries of regional and national influenza data and free subscriptions to CDC�s Morbidity and Mortality Weekly Report and Emerging Infectious Diseases Journal. The most important consideration is that the data provided are critical for protecting the public�s health.

For more information on influenza sentinel provider surveillance, please contact Delmar Little, MPH � Influenza Surveillance Coordinator for the Georgia Department of Public Health � at 404-463-4625 or by email at delittle@dhr.state.ga.us.

November 6, 2012

West Nile Virus in Georgia

The Georgia Department of Public Health has identified 21 confirmed cases of the West Nile Virus in our state at the time of this alert, August 24, 2012. (There are probably additional cases by the time you read this article). Three of these cases were fatal. Confirmed cases were found in the following counties: Bartow, Cobb, Columbia, Dougherty, Fulton, Forsyth, Lee, Mitchell, Muscogee, Richmond, and Worth. All areas of Georgia are at an elevated risk as more case confirmations have been made this year than in years past, and more mosquitoes are found carrying the virus.

West Nile Virus infection can be suspected in a person based on clinical symptoms and patient history. Laboratory testing is required for a confirmed diagnosis. The most efficient diagnostic method is detection of IgM antibody in serum collected within 8 to 14 days of illness onset. According to the CDC, symptoms include fever, headache, as well as body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks.

Please ensure that your office or your laboratory testing provider immediately alerts the Department of Public Health to any West Nile Virus confirmations by calling 1-866-PUB-HLTH (1-866-782-4584).

October 9, 2012

Family Physician's Role in Treating Domestic Violence

Exposure to violence during childhood can have an impact on the health and development of children. Studies have shown that children whose mothers are victims of domestic violence are less likely to receive well-child visits and are less likely to be fully immunized by age two. The effects of living in a home where domestic violence occurs continue further into childhood and adolescence. Research has found that these children face developmental delays, exhibit aggressive behaviors, and have higher rates of substance use and teen pregnancy.

Family physicians can play a role in addressing childhood exposure to family violence. A mother who is experiencing domestic violence has difficulties connecting with resources because of the partner's control. However, abusive partners will allow women see a physician, either for themselves or for the children. In these visits, the primary care provider can screen for domestic violence by asking questions like, "Are you in a relationship with someone who threatens or physically hurts you?" Because many women are unaware of the impact of violence on their children, screening provides additional opportunities for discussions with mom around the negative impacts of family violence on children. Based on the answers given, the family physician and their staff can make referrals to local domestic violence agencies or other community agencies.

While we know there are negative effects of exposure to family violence, we also know that the presence of a strong relationship with the non-battering parent is paramount in how a child responds to the violence. Working to keep the mother safe is the best, most efficient way to keep the children safe. The physician being willing to screen and refer mom can have a tremendous impact on the health and safety of children. Local domestic violence agencies can work with moms and children to help mitigate the negative effects of the violence. Crisis line services are available 24/7 throughout GA by calling 1-800-334-2836. If you would like more information or resources for your practice, please contact Angie Boy, DrPH at 404-209-0280 or aboy@gcadv.org.

May 1, 2012

Pertussis Materials Now Available from the Department of Public Health

During the 2011 legislative session the Georgia General Assembly passed House Bill 249, requiring each hospital in the state of Georgia to provide parents of newborns educational information on pertussis disease and the availability of a vaccine to protect against the disease. This law went into effect July 1, 2011.

Through collaboration with the Georgia Hospital Association, the Georgia Chapter of the American Academy of Pediatrics, the Georgia Academy of Family Physicians, and the Georgia Obstetrical and Gynecological Society, the Georgia Department of Public Health (DPH) is pleased to provide pertussis materials to the public and medical community in support of this legislation. Samples of these new materials have been mailed to all birthing hospitals throughout the state. Electronic versions for duplication are available on the DPH website at www.health.state.ga.us/pertussis.

Pertussis is a very contagious respiratory disease that poses a severe health risk and potential death to infants who can catch it from adults who do not know they are ill with pertussis. Tdap vaccination for anyone, age 11 years or older, who will be in close contact with an infant, is an important way for families to protect an infant. This legislation and supporting DPH resources will assist providers with protecting Georgia's youngest citizens.

If you have any questions about this DPH initiative, contact immunization@dhr.state.ga.us.

May 1, 2012

Report STDs to Reverse STD Morbidity

Working in cooperation with state officials, local health departments and community organizations, family physicians play a vital role in promoting the reproductive health of Georgians. By promoting effective prevention and treatment strategies, family physicians help reverse escalating morbidity associated with sexually transmitted diseases (STDs). To that end, all Georgia-licensed physicians, laboratories and healthcare providers are required by law to report patients with conditions of public health concern, including STDs.

Appropriate and timely reporting using the Notifiable Disease/Condition Report Form or State Electronic Notifiable Disease Surveillance System (SENDSS) enables the Georgia Department of Public Health (GDPH) to follow up, identify potential outbreaks and foster a better understanding of health trends in Georgia. GDPH surveillance is conducted on more than 50 diseases and conditions to:

Identify in a timely way any diseases or conditions requiring immediate GDPH intervention and follow up;
Detect changing trends or patterns in disease occurrence;
Identify areas or communities requiring special GDPH response as a result of changes in disease patterns; and
Assess and evaluate control and prevention interventions.

Paper reports may be filed by completing the Notifiable Disease/Condition Report Form and mailing or faxing the report to the appropriate GDPH District Health Office in an envelope marked "CONFIDENTIAL." Access a copy of the report form at: http://health.state.ga.us/pdfs/epi/notifiable/reportingform.05.pdf.

SENDSS allows members to electronically report cases to expedite STD reporting and reduce administrative paperwork. Physicians new to SENDSS must register for a user account by following these steps:

Connect to https://sendss.state.ga.us/sendss/login.screen.
In the first sentence of the screen, first-time users should select "click here" and complete all the areas on the registration form shaded in dark pink.
For help or questions regarding the SENDSS registration and login instructions, please contact the SENDSS Administrator at 404-657-6450.

Once registered, SENDSS allows authorized users to input data and submit reports according to specified time intervals. Conditions such as syphilis must be reported immediately, while others, like chlamydia and gonorrhea, should be reported within seven days.

Physicians are asked not to use the SENDSS form if reporting HIV infection and AIDS in adults and adolescents. For these conditions, complete the CDC form 50.42A for adult cases, which may be accessed at http://health.state.ga.us/pdfs/epi/hivstd/AIDS%20Adult%20CRF%202011.pdf; and complete the HIV/AIDS confidential case report for adolescent and younger cases, which may be accessed at
http://health.state.ga.us/pdfs/epi/notifiable/aids-pediatric.crf.03.pdf.

A Georgia AIDS/STD Hotline for questions about a particular STD test or treatment is available for clinicians or patients by calling 1-800-551-2728 weekdays from 8 a.m. to 8 p.m.

References: http://health.state.ga.us/pdfs/prevention/std/2011%20STD%20Awareness%20Month%20Activities.pdf

http://health.state.ga.us/programs/std/reporting.asp

http://health.state.ga.us/pdfs/epi/notifiable/reportingform.05.pdf

May 1, 2012

Family Physicians Play an Important Role in Newborn Hearing Screening

To develop and sustain comprehensive coordination between hospitals, primary care providers and the Georgia Department of Public Health, the Universal Newborn Hearing Screening and Intervention (UNHSI) initiative was implemented in 1999. Under UNHSI provisions and Georgia law, parents of newborns must be educated on the importance of hearing screening. Infants not passing the initial and follow-up hearing screenings receive a diagnostic evaluation and, when appropriate, are enrolled in intervention ideally before three and six months, respectively. A suspected or confirmed hearing loss in a child birth to five years old is a notifiable disease in Georgia. Those who perform the screening must report any newborn not passing the hearing screening to the Georgia Department of Public Health Children 1st program within 7 days of screening or confirmatory diagnosis, to help assure the baby has access to the follow-up services and resources he or she needs. For more information and to access reporting forms visit: http://www.health.state.ga.us/programs/unhs/reporting.asp

The sooner a family knows about a child's hearing loss and the options for a meaningful and effective response, the better the opportunity for intervention and clinical success. Family physicians play an important role in helping parents and siblings identify and embrace programs and communication methods for children with hearing loss. In addition to providing check-ups and immunizations, family physicians are catalysts for referrals to an audiologist, otolaryngologist, ophthalmologist, genetics and early intervention services for thorough and prompt evaluations.

All licensed Georgia physicians are required to educate their patients about newborn hearing screening. Hospitals that perform hearing screenings are required to submit quarterly reports on the numbers of newborns screened, number passed and number failed.

The state office for UNHSI collects screening data from all Georgia birthing hospitals each quarter. Data from state fiscal year 2009 indicated that over 98 percent of Georgia's newborns had received a hearing screening prior to hospital discharge. Of those babies not passing the initial hospital inpatient screening, 44 percent were documented as not receiving a rescreen or diagnosis in 2009. Family physician's play a crucial role in knowing the results of the initial screen, making appropriate referrals for babies not passing, and ensuring family follow up. The longer the infant goes without an appropriate diagnosis the greater the loss of exposure to language and communication.

To assist and educate patients, family physicians may access free UNHSI information through the CDC website at http://www.cdc.gov/ncbddd/hearingloss/index.html

May 1, 2012

Adolescent Health & STDs

The AAFP recommends high-intensity behavioral counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs. (2008)^[1]

With reports of increased sexual activity among today's adolescents, family physicians are faced with the task of not only diagnosing sexually transmitted diseases (STDs), but breaking the news to parents of innocence lost and guiding the process for risk intervention and counseling.

Each year, an estimated 18.9 million new cases of STIs occur in the United States with direct medical costs at approximately $15 billion. Although 15�24-year-olds represent only one-quarter of the sexually active population, they account for nearly half (9.1 million) of new cases of STIs each year.^[2]

Georgia is one of 18 states that allows physicians to inform a minor's parents that he or she is seeking STD treatment or services.^[3] Risk reduction interventions by family physicians to assist in the prevention or reduction of STD risk can help maximize adolescent health and minimize the prevalence of STDs.

Health professionals are required by law to report STDs through the State Electronic Notifiable Disease Surveillance System (SENDSS), but the manner and timing of disclosing STDs in adolescents to parents and guardians is of particular concern. Since many parents are unaware their adolescent is sexually active, the risk for STDs is, in their minds, non-existent. The pressure to reveal information to the families can seem palpable to family physicians in order to intervene and help modify sexual behavior.

Family physicians occupy a unique place in healthcare by helping parents articulate and encourage a strategy to address the latent risks of sexual activity with their adolescents before a diagnosis is made and ensure safety by adhering to specific guidelines and recommendations. For example, the Centers for Disease Control and Prevention now recommends the human papillomavirus (HPV) vaccine for both boys and girls starting at age 11.

Encourage parents to initiate an honest conversation with their adolescent regarding their sexual activity. This may be the first step in preventing or treating STDs and infections including Chlamydia trachomatis, hepatitis B, hepatitis C, herpes simplex, HIV, HPV, Neisseria gonorrhea, syphilis, and Trichomonas vaginalis. All sexually active adolescents are at increased risk for STDs and should be offered counseling. Among the studies reviewed, successful high-intensity interventions were delivered through multiple sessions, most often in groups. This is where family medicine and community organizations/resources can work together providing intersecting care - physically, developmentally and emotionally.

Reinforce the subject by informing parents about STD treatment options and risks. STDs do not go away over time without proper treatment. STDs commonly are asymptomatic for months. In some cases, symptoms may never manifest. Without proper diagnosis and treatment, adolescents remain at risk for complications including infertility, pregnancy loss, cervical cancer from untreated HPV, the increased risk of HIV transmission, and in some cases, death. Armed with the ominous possibility of such serious side effects of untreated STDs, parents are better equipped at talking honestly about sexual reproductive health and risks.

Though birth-control pills do not prevent STDs, latex male condoms used correctly and consistently reduce the risk. Teenagers who substitute oral sex for higher risk intercourse are exposed to potential health hazards as well. All adolescents engaged in oral, vaginal or anal sexual activity and/or whose partner has STD symptoms should be tested annually.

In his 1999 editorial in American Family Physician entitled Thinking about Sexually Transmitted Diseases, George Schmid, M.D., M.Sc., Centers for Disease Control and Prevention in Atlanta, GA outlined his recommendations for appropriate interventions. "We can choose the most appropriate therapy; avoid the use of "polypharmacy" and, thus, avoid excess cost and development of antimicrobial resistance; give appropriate counseling; better manage the patient if prescribed therapy fails; and determine the need for appropriate partner notification."

Though abstinence is the only fully effective method of preventing STDs, "an ounce of prevention is worth a pound of cure." Family physicians have the opportunity to form a compelling alliance with parents of teenagers in the fight against STDs. With a foundation of trust and an informed approach, family physicians help foster the well-being and sexual health of families for generations.

References: http://health.state.ga.us/programs/std/faq.asp#surveillance

http://www.thecommunityguide.org/hiv/adolescents.html

^[1] American Academy of Family Physicians. Recommendations for Clinical Preventive Services. Leawood, KS: American Academy of Family Physicians; 2007. Accessed at www.aafp.org/online/en/home/clinical/exam/p-t.html on 17 June 2008.
^[2] Weinstock H et al., Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000, Perspectives on Sexual and Reproductive Health, 2004, 36(1):6�10.
^[3] Guttmacher Institute, Minors' access to STI services, State Policies in Brief as of March 2012. http://www.guttmacher.org/statecenter/spibs/spib_MASS.pdf

April 1, 2012

Influenza Sentinel Providers � Contributing to the Public's Health

What is an influenza sentinel provider?
An influenza sentinel provider conducts surveillance for influenza-like illness (ILI) in collaboration with the local and state health departments as well as the Centers for Disease Control and Prevention. Data reported by sentinel providers, in combination with other influenza surveillance data, provide a picture of influenza virus and ILI activity in the United States. Approximately 3,000 providers throughout the country were enrolled in this network during the 2009-2011 influenza season; 74 of them were Georgia sentinel providers.

What, how and to whom are data reported?
Sentinel providers report the total number of patient visits each week and the number of patient visits for influenza-like illness by age group (0-4 years, 5-24 years, 25-49 years, 50-64 years, >=65 years). These data are transmitted once a week over the Internet or via fax to CDC. Most providers report that it takes them less than 30 minutes a week to compile and report their data. In addition, sentinel providers submit specimens from a subset of patients for virus isolation free of charge monthly during the influenza season. The Georgia Public Health Laboratory types the viruses; many of these are then forwarded to CDC for viral characterization.

Sentinel providers receive feedback on the data submitted, summaries of regional and national influenza data and free subscriptions to CDC's Morbidity and Mortality Weekly Report and Emerging Infectious Diseases Journal. The most important consideration is that the data provided are critical for protecting the public's health. For more information on influenza sentinel provider surveillance, please contact Delmar Little, MPH � Influenza Surveillance Coordinator for the Georgia Department of Public Health � at 404-463-4625 or by email at delittle@dhr.state.ga.us.

March 26, 2012

Georgia Physicians Required to Report Abortions Performed

The Woman's Right to Know Act (WRTK) requires physicians performing abortions to submit an annual reporting form to the Department of Public Health (DPH).

On December 1, 2011 DPH released a letter to physicians regarding reporting requirements under the WRTK Act. The letter is available on the GAFP website.

The WRTK law requires that pregnant women seeking an abortion are offered the opportunity to view an ultrasound and hear the fetal heartbeat. Geographically-indexed information regarding the availability of free ultrasounds must also be made available. The physician who performs abortions is required to report the number of patients who were provided the opportunity, and of that number those who elected to view the sonogram and those who elected to hear the fetal heartbeat.

Under this law, physicians performing abortions must submit the WRTK Annual Reporting form available at http://health.state.ga.us/wrtk/physicians.asp on or before February 28 of every calendar year, or be subject to a late fee of $500. Additionally, the physician will be reported to the Composite Board of Medical Examiners. The referenced statutes may be accessed at http://www.legis.state.ga.us. The Annual Reporting Form is also available on the GAFP website.

If you have questions about the reporting requirements, please contact the Maternal and Child Health Program, Perinatal/Women's Health Unit at 404-651-7691 or by email at wrtkinfo@dhr.state.ga.us.

February 10, 2012

Atlanta STI Resource for Underserved: SisterLove, Inc.

SisterLove, Inc. (SLI) in partnership with the Georgia Department of Public Health is pleased to announce the launching of its new expanded STI Testing Program. A long sought after goal, SLI now provides testing services beyond HIV to communities of color at low or no cost. As part of the Georgia Infertility Prevention Project (IPP), Sister-Love now offers Chlamydia and Gonorrhea testing.

SisterLove's established presence and positive reputation in various communities eased the expansion of this initiative to include Chlamydia and Gonorrhea testing as an addition to rapid HIV testing and counseling program. Through this new expanded program, patients have the option of free testing as well as referrals to treatment sites if they test positive. SLI has three partner sites that will provide prescriptions for cost-effective treatment. The patient has the option to seek services at the clinic that is most convenient for her or him.

SisterLove has partnered with medical centers to increase access to treatment and care in Atlanta. Andrea Saboor, MSN, FNP-C, provides pro-bono treatment services at Absolute Care Medical Center in Midtown. In addition to receiving free treatment, the patient will also be screened for Syphilis free of charge. Hermeyone Wilson, APRN, provides space at the Edgewood Medical Center for SLI to offer free HIV/STI screenings. With this new IPP initiative, SisterLove is able to provide greater prevention and intervention services to underserved minority communities.

For additional information contact Michelle Allen, State STD Office Director - Georgia Department of Public Health, Office of Infectious Disease and Immunization Program mlallen2@dhr.state.ga.us

December 20, 2011

GAFP Members in Northeast Georgia: Now Hear This!!!

The New Hearing Screening Follow-up Clinic is busy working with families and physicians to increase follow-up infant hearing screenings in the Gainesville Health District.

The Georgia Universal Newborn Screening and Intervention (UNHSI) program is responsible for ensuring that every infant with hearing loss born in Georgia is diagnosed and linked to early intervention services by 6 months of age, in accordance with national Early Hearing Detection and Intervention (EHDI) goals. To meet this goal, infants who fail the initial hospital screen need access to follow-up screening services.

In 2010, the District 2 UNHSI program opened a new clinic dedicated to providing outpatient services for infants who require follow-up newborn hearing screens. The clinic opened in response to the Northeast Georgia Medical Center no longer offering outpatient follow-up newborn hearing screens. The new clinic provides timely follow-up screening services to infants who missed or received a "refer" result on their initial hearing screen. In addition to serving infants, clinic staff also provides education to families, physicians and other providers on the importance of screening, tracking, and follow-up for these babies. The clinic uses Automated Auditory Brainstem Response (AABR) equipment, which tests the entire hearing pathway from the ear to, and including, the brainstem.

The clinic has grown significantly, increasing operation from a one-half day session per month to a full day clinic twice per month. The average number of patients screened in the clinic has climbed from two to fourteen. The number of infants tracked for follow-up hearing screening increased from 72 percent in state fiscal year (SFY) 2010 to 93.4 percent in SFY 2011. The total number of infants tracked to audiological diagnostic evaluation also increased from 55.5 percent in SFY 2010 to 94.5 percent in SFY 2011. The staff believes the success of the clinic is a result of having more control over the scheduling of appointments, having more time to educate parents on the need for audiological intervention and giving providers follow-up information at the same time that they receive the results of the screening.

In April 2011, District 2 also received additional funds to purchase Automated Tympanometry Screening equipment to test babies that do not pass follow-up AABR or Automated Otoacoustic Emissions (AOAE) hearing screens. Screening tympanograms are used to evaluate middle ear functioning by measuring pressure within the middle ear. Tympanograms can assist in identifying if fluid in the middle ear is the cause for an infant not passing the initial and follow-up hearing screen. District 2 staff trained with an audiologist on the use of the equipment and began including tympanograms in all follow up screening procedures in August 2011. Future plans include hiring an audiologist and expanding services to include diagnostic ABR.

For further information about the Gainesville UNHSI Newborn Screening Follow-up Clinic contact Florence Freeman, RN, the Universal Newborn Hearing Coordinator at fmfreeman@dhr.state.ga.us or Tonya Newsom, LPC, MA, MBA, the Children 1st & Language Access Coordinator at tenewsom@dhr.state.ga.us.

December 20, 2011

Family Physicians Integral in Early Detection of Hearing Loss

Georgia's Universal Newborn Hearing Screening and Intervention (UNHSI) program is an early hearing detection and intervention program aimed at preventing delays in language and social-emotional development. Family physicians make a substantial difference in the success of Georgia's UNHSI program by acting as a primary referral source and advocating on behalf of their patients for timely follow up services. Understanding the UNHSI program and advocating for hearing screening is the critical link in promoting positive social, emotional and educational outcomes for children at risk for hearing loss.

Georgia's UNHSI program begins with an initial hearing screening in the hospital. If the infant passes this screening, with no risk factors present, then the physician is notified that no further testing is necessary via the discharge paperwork. However, if the infant either does not pass the screening (also known as 'refers' or 'fails'), does not receive the screening, or passes with risk factors present, the physician is notified that further testing is necessary by the appropriate UNHSI District Coordinator. The UNHSI District Coordinators responsibility is to work in partnership with the parents and physician to obtain appropriate follow up testing and intervention services for the infant if necessary. To contact the UNHSI Coordinator in your area call 404-657-4143.

To meet the National Early Hearing Detection and Intervention (EHDI) goal of initial screening by one month of age, it is important to refer these infants for a follow up hearing screening within two weeks of receiving the referral. The follow up screening is performed to rule out the suspicion of hearing loss and to determine whether or not further diagnostic testing is necessary.

There are two types of hearing screening tests that can be performed on infants. Automated Otoacoustic Emissions (AOAE) testing involves placing a small probe at the entrance of the ear canal and measuring an 'echo' response from the inner ear. Automated Auditory Brainstem Response (AABR) testing involves placing electrodes several places on the infant and measuring brainwave response elicited by an auditory stimulus. Both tests are simple and nonintrusive to the infant.

The type of hearing screening test performed during follow up is determined by the type of hearing screening the infant received in the hospital. If an AOAE has been performed on the infant in the hospital, then follow up screening can be completed with either an AOAE or an AABR. If an AABR has been performed on the infant in the hospital, then follow up MUST be completed utilizing an AABR. An AABR is required because an AOAE does not diagnose a type of hearing loss known as Auditory Neuropathy. Thus, an infant may fail an AABR and pass an AOAE but still have profound permanent hearing loss. Therefore, to ensure that patients are receiving the most appropriate and comprehensive care, it is vital that physicians are aware of the type of hearing test that has been performed in the hospital and the type of hearing test being performed during follow up.

For questions on follow up hearing screening or diagnostic hearing testing, call Sarah Rank, AuD, State UNHSI program Coordinator, at (404) 657-4143. To make a referral to the Children 1st Program call 1-800-822-2539. You may also contact Cathi Durham, GAFP Director of Outreach at 800-392-3841 or cdurham@gafp.org.

April 6, 2011